title: Candida sake as the causative agent of spondylodiscitis in a hemodialysis patient.
abstract: BACKGROUND
  Fungal spondylodiscitis is often because of Candida albicans or other common Candida species, whereas unusual strains such as Candida sake are often thought to be nonpathogenic.
  
  
  OBJECTIVE
  To report the first case of spondylodiscitis caused by C sake and its outcome after antimycotic therapy; as the disease occurred in a patient undergoing hemodialysis (HD), we also discuss the potential conditions related to the uremic state and to HD itself, which may predispose to spondylodiscitis.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Report of the patient's clinical findings and review of the literature concerning spondylodiscitis in HD patients and infections caused by C sake.
  
  
  RESULTS
  The patient was a 48-year-old woman with end-stage renal disease (ESRD) undergoing HD who presented with back pain; spine computed tomographic (CT) scans showed lumbar spondylodiscitis with large bilateral abscesses in the psoas muscles, with an imaging appearance resembling that of Pott's disease. Surprisingly, C sake was isolated from the cultures of the liquid obtained by CT-guided aspiration of both abscesses, and fluconazole therapy was strikingly effective in inducing abscess regression and healing of spondylodiscitis.
  
  
  CONCLUSIONS
  In patients with chronic disorders such as ESRD, spondylodiscitis can also be caused by rare fungal strains that are usually thought to be nonpathogenic; a correct diagnostic workup is essential, as such forms can promptly respond to common antimycotic agents.
authors.affiliation: Department of Clinical Medicine, Nephrology and Health Sciences, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Palmisano
authors.forename: Magda
authors.initials: M
authors.lastname: Benecchi
authors.forename: Massimo
authors.initials: M
authors.lastname: De Filippo
authors.forename: Umberto
authors.initials: U
authors.lastname: Maggiore
authors.forename: Carlo
authors.initials: C
authors.lastname: Buzio
authors.forename: Augusto
authors.initials: A
authors.lastname: Vaglio
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification* / Q000502:physiology; D002177:Candidiasis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D015299:Discitis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D006435:Renal Dialysis; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole